The discovery of gas in infected tissues is usually very alarming, since gas gangrene is immediately suspected. However, on further clinical and laboratory investigation, it may be found that infection by virulent clostridial organisms has not occurred and that acute nonclostridial crepitant cellulitis is the real cause.
Associated with cellulitis, subcutaneous emphysema may be caused by the following factors:
I. Extrinsic factors
A. Physical introduction of air by
1. Severe trauma (with partial avulsion)
2. Improper irrigation of wounds
3. Injuries involving the organs of respiration
B. Chemical generation of gas
II. Intrinsic factors
A. Infection by aerogenic bacteria
1. Clostridial bacteria
2. Other bacteria
The infected wound may possess gas introduced extrinsically by physical means, such as severe trauma, improper irrigation of wound, injuries involving respiratory organs, or chemical generation of gas by such agents as hydrogen peroxide. Examples of this type of infection have been reported by Rubenstein,
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